Patient safety in cataract surgery.

PURPOSE: The recent focus on healthcare errors and safety suggest that practitioners and policy makers might appraise their cataract surgical care from a patient safety perspective. This paper reviews patient safety issues relevant to cataract care. Causation and consequences of incidents in cataract surgery, with implications for policy, are discussed. METHODS: Models of accident causation from other domains were drawn on and empirically applied to cataract care. Consultation was undertaken with experts in cataract surgery, patient safety, and in risk management. Feedback on patient safety was included from presentations made to staff and patients and from personal insights. RESULTS: Ophthalmology teams should embrace steps to improve patient safety. The role of incident reporting is advanced, including the provision of a prompt menu of cataract patient safety incidents as suggested by the Royal College of Ophthalmologists. CONCLUSIONS: Strict attention to detail, risk assessment, and careful consideration of the patient pathway is needed to enhance cataract care. Clinical errors, near misses and complications happen, and may provide an opportunity for learning to reduce the risk of similar events in the future. Investment in staffing and training, appropriate equipment, and development of a safety culture with patient involvement are key elements of safe cataract surgical care. Patients and the public expect that safe cataract care should be commissioned for them. Critical patient safety incidents, including incidents that have led to permanent harm, require careful analysis of underlying systems and/or root causes.

Optic neuropathy in uraemic patients on dialysis.

Optic nerve disease has been reported in patients with renal failure. A toxic aetiology has been postulated. The incidence of this complication of renal failure has not been determined. We observed 60 patients with renal failure on dialysis for 24 months to determine the incidence of optic neuropathy. Four patients developed typical acute ischaemic optic neuropathy. Their case notes were reviewed in order to determine the pathogenesis. Each patient had long-standing renal failure and its sequelae of anaemia and hypertension. The immediate causes of ischaemia were hypotension in 1, severe anaemia in 1, and generalised atherosclerosis in 2 patients.

Penetration of mercury from ophthalmic preservatives into the human eye.

Single corneas of nine patients about to undergo full-thickness corneal keratoplasty were exposed to thiomersal by application of a hydrophilic gel contact lens preserved with this mercurial agent. These lenses were removed at operation 4 h later, and the lenses, corneal buttons, and samples of aqueous were taken for determination of total mercury by wet digestion and flameless atomic absorption. The contact lenses contained little residual mercury, but mercury was readily detected in the corneal buttons and in the samples of aqueous over the range of 1--60 ng/ml. Five control samples of aqueous obtained without exposure to mercurial preservatives contained less than 1 ng/ml mercury. Although specific effects on ocular function are not described, the use of these preservatives is associated with penetration of mercury into the aqueous in concentration similar to those reported with systemic poisoning by organic mercurials.